FOAM: A Framework to Design Effective Handwashing Programs

In November 2006, the Water and Sanitation Program (WSP) began implementing the Global Scaling Up Handwashing Project to test whether innovative promotional approaches could generate widespread and sustainable increases in rates of handwashing with soap at critical times—and thus reduce rates of diarrhea and acute lower respiratory infection—among the poor and vulnerable in Peru, Senegal, Tanzania, and Vietnam.

The global project team soon realized they needed a common conceptual framework that would be applicable across the participating countries.

In response to this need, in March 2007 WSP organized a workshop in Hanoi, Vietnam, attended by the global team and participants from partner organizations. Guided by Population Services International's PERForM framework, participants developed FOAM to inform the design and implementation of the project, strengthen formative research and monitoring and evaluation, and create a shared technical vocabulary.

FOAM—which stands for Focus on Opportunity, Ability, and Motivation—is based on behavioral determinants that either promote or constrain behavior change. “Any handwashing project can benefit from FOAM,” says Coombes. “The framework breaks the behavior of handwashing with soap behavior down into behavioral determinants to see which determinants, when mediated in a particular setting with a specific target group, are most likely to have the greatest impact on handwashing behavior.”

The FOAM framework, developed for use in resource-poor settings, can be adapted across diverse socioeconomic environments. Indeed, one of the guiding principles of the workshop was that the FOAM framework should be flexible and therefore universal in its application. This flexibility has enabled WSP’s global project team to “better target our messages, develop materials, and use various communication channels to reinforce our messages,” says Nga Kim Nguyen, country team task manager in Vietnam.

Currently being applied by WSP’s Global Scaling Up Handwashing Project in Peru, Senegal, Tanzania, and Vietnam, FOAM is intended for use by program managers implementing handwashing behavior change initiatives, as well as multilateral and bilateral agencies, academic institutions, and government and nongovernmental organizations (NGOs) working in water and sanitation. As additional research findings are incorporated and new studies are conducted, the authors expect FOAM to evolve to meet the needs of handwashing programs.